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Original research
Exercise as a substitute for traditional airway clearance in cystic fibrosis: a systematic review
  1. Nathan Ward1,2,
  2. Scott Morrow1,
  3. Kathy Stiller3,
  4. Anne E Holland2,4,5
  1. 1Physiotherapy and Cystic Fibrosis Services, Royal Adelaide Hospital, Adelaide, South Australia, Australia
  2. 2Department of Physiotherapy, Podiatry, and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
  3. 3Allied Health, Central Adelaide Local Health Network, Adelaide, South Australia, Australia
  4. 4Physiotherapy, Alfred Health, Melbourne, Victoria, Australia
  5. 5Allergy, Immunology and Respiratory Medicine, Monash University, Clayton, Victoria, Australia
  1. Correspondence to Nathan Ward, Royal Adelaide Hospital, Adelaide, SA 5000, Australia; nathan.ward2{at}


Background Exercise and traditional airway clearance techniques (ACTs) are both routinely recommended for people with cystic fibrosis (CF), with some people using exercise as a substitute for traditional ACTs. The effectiveness of this is unclear. We systematically reviewed the evidence for using exercise as a substitute for traditional ACTs in people with CF.

Methods A systematic database and literature search were undertaken of studies comparing exercise to rest or traditional ACTs. Primary outcomes were respiratory function, respiratory exacerbations and health-related quality of life. Secondary outcomes included mucociliary clearance (MCC), sputum weight and ease of expectoration. Data are mean difference (95% CI).

Results A total of 12 studies (15 reports) were included, all of short duration (single session to 2 weeks). In crossover trials, exercise did not improve forced expiratory volume in one second in comparison to rest, but peak expiratory flow was increased during treadmill exercise (mean difference (MD) range 1.00–1.16 L/s) and cycle ergometry (1.19 (0.96 to 1.42) L/s). Treadmill exercise improved MCC (2.6 (1.6 to 3.6)%) and ease of expectoration (MD range 1.3–1.8 cm) compared with rest. No consistent differences in respiratory function were evident when exercise was compared with traditional ACTs (four crossover studies). There was no significant difference in MCC or sputum weight in studies where forced expirations were included in the exercise intervention.

Conclusions Exercise improves ease of expectoration and sputum clearance compared with rest. Exercise, incorporating forced expirations, may have similar effects to traditional ACTs over the short term. There are no data comparing exercise to traditional ACTs over the longer term.

PROSPERO registration number CRD42018102780.

  • cystic fibrosis
  • exercise
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  • Contributors Study design: NW, SM, KS, AEH. Data collection: NW, SM. Data analysis: NW, SM, KS, AEH. Draft manuscript: NW. Manuscript review: NW, SM, KS, AEH.

  • Funding This study was supported by an Australian Government Research Training Programme Scholarship.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available.

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